תוצאת חיפוש

Miliary and Reticulo-Nodular Pulmonary Brucellosis

Nasser Gattas, Norman Loberant, David Ri

Medical Dept. B and Radiology Depts., Western Galilee Regional Hospital, Nahariya and Rappaport Faculof Medicine, The Technion, Haifa

Brucellosis is a classical zoonosis caused by a Gram-negative bacillus of the genus Brucella. Human brucellosis can either be acute or chronic and present with a variety of manifestations, mostly with fever and signs of musculo-skeletal involvement. It may be complicated by involvement of the cardiovascular, central nervous or genito-urinary systems. However, pulmonary brucellosis is a rare complication.

We report a case of miliary and reticulo-nodular brucellar pneumonia with positive blood and sputum cultures and positive serological tests. To the best of our knowledge this is the first case to be reported from Israel of miliary pneumonia with sputum positive for brucellosis.

Spontaneous Internal Jugular Vein Thrombosis Complicating Chronic Pulmonary Disease

Nir Hilzenrat, Edit Liberty, Luna Avnon

Depts. of Medicine B and E, and Pulmonary Disease Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba

Spontaneous internal jugular thrombosis is a rare vascular disorder. It usually occurs as a result of external pressure due to a tumor, infection or as a result of damage to the vessel wall after trauma or central venous catheterization. We report a 35-year-old woman who suffered from severe pulmonary hypertension due to chronic cystic lung disease. She was admitted due to sudden, severe, right-sided neck pain. Internal jugular occlusion by a thrombus was demonstrated by ultrasound and CT-scans but no apparent cause was found. We postulated that the important factors in the development of her thrombosis were stasis due to pulmonary hypertension and high blood viscosity.

Nasopharyngeal Colonization with Streptococcus Pneumoniae in Pediatric Respiratory Infections

Isaac Srugo, Irena Chystiakov, Ella Cohen, Yoram Tal, Michael Jaffe

Clinical Microbiology and Pediatric Depts., Bnai Zion Medical Center and Technion Faculty of Medicine, Haifa

During the winter of 1995, nasopharyngeal colonization of Streptococcus pneumoniae was evaluated in 204 children with respiratory infection and 107 normal control children. There was no difference in gender or mean age between the groups, and no difference in carrier rate between sick (24.5%) and normal (22%) children (p=0.6). Carrier rates were 19%, 32%, 31% and 17% at 6, 12, 24 and 48 months, respectively. Penicillin-resistant pneumococci (PRP) were found in 42% of sick and 16.6% of normal children, (p<0.05). Resistance to more than 2 antibiotics was found in 28% of sick and in 12.5% of normal children. PRP were found in 67% and 34% of sick children with and without prior antibiotic treatment (p<0.05). We conclude that there is no difference in the carrier rate of Streptococcus pneumoniae between sick and normal children. However, the high prevalence of PRP in children with respiratory infections is probably due to prior antibiotic treatment.

Diagnosis of Hyperprolactinemia: Determination at Rest Rules Out Stress-Induction

Avraham Ishay, Rafael Luboshitzky

Endocrine Institute, HaEmek Medical Center, Afula and Rappaport Faculty of Medicine, The Technion, Haifa

We present 3 women who were referred for evaluation of stress-related mild-to-moderate hyperprolactinemia. This frequent finding may mistakenly be considered a clinical problem, and lead to inappropriate investigation and therapy. We emphasize the importance of serial blood sampling for prolactin determination. We collected blood samples repeatedly under resting conditions from an indwelling venous brachial catheter, every 30 minutes for a total of 6 samples. All 3 patients had normal prolactin levels 30-60 minutes after starting the test. Neither further investigation nor medical therapy were needed and these anxious patients were reassured that their hyperprolactinemia was factitious.

Empirical Treatment of Urinary Tract Infections in the Delivery Room

Peter Jakobi, Orly Goldstick, Renato Finkelstein, Joseph Itzkovitz-Eldor

Obstetrics and Gynecology Dept. and Infectious Disease Unit, Rambam Medical Center, Haifa

Urinary tract infection (UTI) is the most common bacterial infection during pregnancy. In prenatal and delivery wards treatment is usually started at once in pregnant women with symptoms suggesting UTI, but there is no uniformity as to treatment. We surveyed such treatment in the delivery rooms throughout Israel, and whether the treatment differed in simple cystitis as opposed to pyelonephritis. Results of positive urine cultures from symptomatic parturients admitted here during 1995-1996 were examined.

There were 17 different empiric treatment protocols in 28 delivery rooms, whose daily cost ranged from 1-119 NIS. We present the antimicrobial sensitivity of 156 bacteria isolated from the urinary cultures from pregnant women in our prenatal ward. Based upon urinary flora, sensitivity and daily cost, we suggest a protocol for empiric treatment. We recommend first and second generation cephalosporins for treatment of simple lower (UTIs), while gentamicin is suggested for treatment of clinical pyelonephritis during pregnancy. There is no medical nor economic justification for the multiplicity of empiric treatment protocols currently used. Considering our results, our protocol is cost-effective for the empiric treatment of UTI in hospitalized parturients and in the community as well.

Transcatheter Closure of Atrial Septal Defects: Initial Clinical Applications

Shahar Zimand, Einat Birk, Mira Frand, Patricia Benjamin, Julius Hegesh

Dept. of Pediatric Cardiology, Sheba Medical Center, Tel Hashomer and Schneider Medical Center, Petah Tikva

The incidence of congenital heart defects is 0.8% of live-born infants. Of these 13% are ostium secundum atrial septal defects (ASD) which can be successfully repaired by open heart surgery with less than 1% mortality. However, morbidity associated with cardiac surgery is universal. Transcatheter closure of ASDs was introduced 2 decades ago to decrease surgical complications, hospital stay and cost. Few devices have undergone clinical trials but all of them have been associated with instances of failure and complications. The most important mechanism for acute failure was selection of cases with too large a defect or selection of a defective device. In the past decade great progress has been made with the aid of transesophageal echocardiography (TEE) and modifications of the device. We present our experience in our first 5 patients. They ranged in age from 4 to 27 years; the ASD diameter was 11-15 mm and the device diameter was 17-33 mm. All transcatheter closures were performed on the same day without any complications, and all patients were discharged home after 2 days of hospitalization. We conclude that transcatheter occlusion of ASDs up to 15 mm is feasible, relatively safe and effective. This transcatheter method appears to be a viable alternative to surgery for some patients with secundum atrial septal defects.

Transcatheter Closure of Atrial Septal Defect

Benjamin Zeevi, Michael Berant, Rami Fogelman, Galit Bar-Mor, Leonard Blieden

Cardiology Institute, Schneider Children's Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University

Isolated secundum atrial septal defect is one of the most common congenital heart defects. Surgical closure is the treatment of choice but is associated with a chest scar, some morbidity and a relatively long recovery and the use of cardiopulmonary bypass. Transcatheter closure of secundum atrial septal defect is therefor an attractive approach.

3 children, aged 5-10 years, underwent successful transcatheter closure of moderate to large central atrial septal defects with the Cardioseal device. The procedures were performed under x-ray and transesophageal echocardiographic guidance.

Our initial experience, and that of others, indicates that transcatheter occlusion of secundum atrial septal defects is safe and effective and can be an appropriate alternative in approximately 60% of patients.

Kaleidoscopic Autoimmunity

Yehuda Shoenfeld

Unit for Study of Autoimmune Diseases and Medical Dept. B, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University

We describe an 18-year-old girl with idiopathic thrombocytopenic purpura (ITP) who developed chronic active hepatitis following splenectomy that cured the ITP. This is a phenomenon in which an organ belonging to the immune system is resected, which results in cure of one autoimmune disease but in the emergence of another, apparently unrelated, second autoimmune disease. We refer to this phenomenon as kaleidoscopic autoimmunity, explaining that some autoimmune diseases are not induced by autoantigen-driven mechanisms, but rather result from immune dysregulation.

Rupture of Pectoralis Major Muscle: Operative Treatment of an Uncommon Sport Injury

Moshe Weisbort, Gad J. Velan, David Hendel

Orthopedics Dept., Rabin Medical Center (Golda Campus), Petah Tikva

Rupture of the pectoralis major muscle in an athlete is rare, but is said to be common in weight lifters. The muscle usually ruptures at the musculotendinous junction during forceful contraction of the muscle in adduction, forward flexion and internal rotation of the arm. We describe an athlete who suffered such a major tear during a rugby game. It was treated surgically and after adequate rehabilitation, athletic activities were resumed.

Characteristics of Israeli Primary Health Care Physicians who Treat Depression

Jonathan Rabinowitz, Dina Feldman, Revital Gross, Wienka Boerma

Bar Ilan University, Ramat Gan; Israel Ministry of Health; JDC-Brookdale Institute, Jerusalem; and Netherlands Institute of Primary Health Care (NIVEL)

Primary health care physicians have a pivotal role in treating mental health problems. We determined the proportion of primary care physicians in Israel who treat depression and their characteristics. The study was based on a stratified national random sample of primary care physicians (n677, response rate 78%). From these physicians' reports 22% always treat depression, 36.6% usually, 28.6% sometimes, and 12.6% never. Based on a logistic regression model the physicians who always or usually treated depression were distinguished from the other physicians by their treating more medical conditions on their own, seeing themselves as having more first contact for psychosocial problems, having frequent contact with social workers and specializing in family medicine. Primary health care physicians play a major role in treating depression on their own. This raises new questions about how they treat depression themselves, and under what circumstances they treat or refer to a specialist.

Epidemiology of Invasive Hemophilus Influenzae B Infections in Bedouins and Jews; Conjugate Hib Vaccines

Limor Gortzak-Uzan*, Drora Fraser, Ron Dagan

Pediatric Infectious Disease Unit and Dept. of Epidemiology, Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheba

From 1989 to 1996, 139 cases of invasive Hemophilus influenzae B (Hib) infections were identified in children in the Negev, 110 of which occurred before introduction of the conjugate vaccine (1989-92). At that time there were 60.5 cases of Hib per 100,000 in the Negev among children under 5 years of age. During 1995-1996, when Hib conjugate vaccine was part of the regular immunization program, Hib decreased to 6.5 cases per 100,000 in that age group. The effectiveness of PRP-OMP vaccine was 96.5% among Jews and 89% among Bedouins, and the efficacy of the immunization program was 99.99%. This degree of success exceeded all expectations based on the literature. During the whole study period, Hib infections were more frequent among Bedouins than Jews. There was no significant difference in the occurrence of Hib among Jews in the Negev before and after the vaccine was introduced. Hib among Bedouins in the Negev was significantly more frequent than in the Israeli population as a whole before the vaccine was introduced. That gap narrowed after the vaccine was introduced because of the decrease in morbidity among the 2 groups.

* Medical student.

Follicle-Stimulating Hormone in Azoospermia in Prediction of Spermatogenic Patterns

David B. Weiss, Shoshana Gottschalk-Sabag, Zvi Zukerman, Elchanan Bar-On, Zvi Kahana

Kupat Holim Me'uhedet; and Dept. of Pathology and Cytology and Male Infertility Unit, Shaare Zedek Medical Center, Jerusalem; Andrology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva; and Paper Research Consultant Institute, Jerusalem

Follicle-stimulating hormone (FSH) is considered to be the most important plasma hormone correlated with spermatogenesis. Elevated FSH plasma levels were shown to be associated with complete damage to testicular seminiferous tubule germinal epithelium. Recently, there have been conflicting reports with regard to the value of FSH plasma levels in predicting seminiferous tubule histology in the azoospermic patient and hence, as a guide for therapy in assisted reproduction using testicular sperm retrieval. The aim of this study was to evaluate whether FSH plasma levels can predict spermatogenic pattern in the testes of the azoospermic infertile patient. 69 infertile men with non-obstructive azoospermia and 18 with very severe oligospermia were studied. In all, plasma levels of testosterone, free testosterone, prolactin, luteinizing hormone and follicle-stimulating hormone were measured by enzyme immunoassay. In the azoospermic patients the seminiferous tubule spermatogenic pattern was determined in testicular aspirates obtained by multiple fine needle aspiration and categorized according to the most mature spermatogenic cell type in the aspirates: Sertoli cells only, spermatogenic maturation arrest or full spermatogenesis. There were no significant differences in plasma levels of any hormone measured except in very severely oligospermic and azoospermic patients. Both normal and elevated levels were detected in all, regardless of seminiferous tubule cytological pattern or plasma FSH in azoospermic patients. It is concluded that plasma levels of FSH can not be used as a predictive parameter, neither for the presence of spermatozoa nor for any other seminiferous tubule cytological pattern in azoospermic infertile men. They cannot serve as guides for selection of azoospermic men for trials of testicular sperm retrieval in assisted reproduction.

Pheochromocytoma Multi-Organ Crisis: Nonseptic Hyperthermia and Shock

Michael Y. Shapira, Elena Zuckerman, Taufic Zuebi, Oded Jurim

Divisions of Medicine and Surgery, Hadassah-University Hospital; Geriatrics Dept.; Herzog Hospital, Jerusalem; and Dept. of Medicine, Yoseftal Hospital, Eilat

Pheochromocytoma usually presents with nonspecific symptoms such as headache, palpitation, chest pain and hypertension. We present a 48-year-old woman hospitalized due to a pheochromocytoma multi-organ crisis (PMC). It consists of a tetrad of symptoms: multi-organ failure, hyperthermia, encephalopathy and unstable blood pressure. Distinguishing PMC from septic shock may be difficult, and requires needs a high clinical index of suspicion.

Background Music in the Family Physician's Surgery: Patient Reactions

S. Zalewsky, S. Vinker, I. Fiada, D. Livon, E. Kitai

Family Medicine Clinics and Dept. of Family Medicine, Sackler School of Medicine, Tel Aviv University

Music is a universal language, and its effects on pain relief and stress reduction are well known. We evaluated patients' opinions of the effects of background music in their family doctors' surgery. Low volume, background, classical music was played in the doctors' surgery on 5 consecutive clinic days. All patients were asked to fill a short anonymous questionnaire on leaving. Among the 135 consecutive patients offered the questionnaire, there was 87.4% compliance. Among the 118 who completed the questionnaire, 95% said that the background music did not disturb them, 89% thought it made them feel better and 80% thought that it aided the doctor's performance. We conclude that low volume, background music in the doctors's surgery may contribute to better doctor-patient interaction, although larger studies are needed to confirm our findings.

Diskitis in Brucellosis not Responsive to Anti-Brucella Treatment

D. Heldenberg, R. Sevi

Dept. of Pediatrics and Orthopedics A, Hillel Yaffe Medical Center, Hadera

A 14-year-old girl with fever and low back pain was diagnosed as having brucellosis and diskitis. Treatment with doxycycline and gentamicin had no effect nor was there any improvement when the treatment was changed to doxycycline and rifampicin. With cessation of this treatment and administration of cloxacillin fever was reduced and the back pain disappeared. After 12 days of IV cloxacillin, she was released from hospital with instructions to continue cloxacillin orally for another 4 weeks. We conclude that when a patient is suffering from brucellosis and diskitis and does not respond to the usual anti-brucellosis treatment, an anti-staphylococcal preparation should be added.